Internal Jugular Venipuncture
(middle or central route)

Note: frequently difficult in the injured due to need to protect c-spine.

1. Place pt supine, 15o head down to distend neck veins and prevent air embolism.  If c-spine cleared, turn head away from venipuncture site.

2. Cleanse, drapes, sterile gloves.

3. Local anaesthetic if awake.

4. Large caliber needle attached to a 10ml syringe with 1ml saline 1cm: insert into centre of triangle formed by 2 lower heads of SCM and clavicle.

5. After skin puncture, keep bevel upward, expel skin plug that may be occluding the needle.

6. Direct needle caudally, parallel to the sagittal plane, at 30o posterior angle with the frontal plane.

7. Slowly advance while withdrawing the plunger of the syringe.

8. When free flow of blood occurs, rotate bevel of needle caudially, remove syringe and occlude with finger to prevent an air embolism.  If vein not entered, withdraw and redirect 5-10o laterally.

9. Insert guidewire while monitoring the ECG.  Remove needle over guidewire.

10. Insert catheter over the guidewire to a predetermined depth (tip should be above right atrium for fluid administration).

11. Connect IV tubing and affix to skin with suture, taping tubing in place also.

12. Get a chest film.

Complications
Pneumo, haemo-thorax.
Venous thrombosis
Arterial / neurologic injury
Arteriovenous fistula
Chylothorax
Infection
Air embolism